A National Initiative to Reduce Child Abuse and Neglect Fatalities and Injuries Through a Collaborative, Community-Based Approach  

Children in the U.S. are healthier and safer than ever before, and medical advances in treating childhood diseases have made enormous strides over the last few decades. Although the overall U.S. child mortality rate has improved over time, the number of child deaths due to abuse and neglect has remained steady or even increased. Each year, somewhere between 1,750 to 3,500 children die from maltreatment. The children who die are quite young. In 2018, 71% of all children who died from maltreatment were younger than three years old. Almost one-half of the children are younger than one year old.
 
Like other causes of childhood illness and death, child maltreatment can be prevented, and the associated risk factors can be addressed. Child maltreatment deaths are not inevitable. This was the message delivered in a groundbreaking report from the U.S. Commission to Eliminate Child Abuse and Neglect Fatalities. In its 2016 report Within Our Reach: A National Strategy to Eliminate Child Abuse and Neglect Fatalities, the commission provided a blueprint for a public health approach that identifies and addresses the root causes of child maltreatment, engages with multiple stakeholders to address these causes collaboratively, and is a shared responsibility between families and communities.

In October 2019, the U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime launched Child Safety Forward, a three-year demonstration initiative to develop multidisciplinary strategies and responses to address serious or near-death injuries as a result of child abuse or neglect and to reduce the number of child fatalities. The efforts will be responsive to the 21st-Century Child Welfare System as envisioned by the federal commission and will result in models for coordinated responses. Within Our Reach, an office at the Alliance for Strong Families and Communities that is supported by Casey Family Programs, serves as the national technical assistance provider to the five demonstration sites.

        The five participating sites are:  

            • St. Francis Hospital in Hartford, Connecticut 
            • Cook County Health in Illinois 
            • Indiana State Department of Health 
            • Michigan Department of Health and Human Services 
            • Sacramento County’s Child Abuse Prevention Council in California 

            The sites are receiving technical assistance from a team of national experts that is geared toward helping them plan and implement an all-systems approach and coordinated strategic planning to respond to and reduce their child maltreatment fatalities and child crime victimization. It will support them in improved data collection and analysis using a safety science approach, development of strong community collaboratives, engagement of persons with lived experiences, and developmental evaluation. 


            In 2019, Indiana completed 
            64.4/1000
            child abuse and neglect assessments.
            The 3rd highest rate in the nation.

            In 2019,
            242,482
            reports were made to the Child Abuse Hotline in Indiana.

            61% 
            of removals of children from their homes in 2019 were related to parental substance abuse.

            195
            child fatalities due to external injury from 2014 to 2018 will be reviewed.

            Retrospective reviews of child fatalities will be conducted in four counties to help identify family and systemic circumstances for those deaths. 

            Once evaluation is complete (through the Indiana University (IU) School of Social Work), the ISDH/IU team will create a plan to mitigate risk factors that affect children in order reduce those fatalities.

            Protocols will include the following:

            • Deploy communications strategy to engage community
            • Conduct ongoing evaluation and lessons learned from retrospective review
            • Develop tools and communicate findings to adjust strategies
            • Implement sustainability plan
             

            An average of 
            10,000 
            reports are made annually in the state of Illinois for deaths, 
            or serious injuries, due to suspected child abuse or neglect.

            It is estimated, 
            50% 
            of children who die from fatal injuries caused 
            by child maltreatment have had no previous contact
            with the child welfare system.

            Retrospective reviews of child fatalities and serious injuries will be conducted in three counties to help identify family and systemic circumstances for those deaths.

            Community stakeholders will explore potential service gaps that may place children at risk for maltreatment including:

            • Healthcare providers
            • Community members
            • Maternal infant health providers
            • Educators
            • Social service providers
            • Faith leaders
            • Law enforcement
            • Child welfare
            • Child advocacy fields

            In addition to facilitating information sharing, Cook County Health will:

            • Convene simulation training and multi-disciplinary team training 
            • Utilize risk analysis mapping of neighborhood “hot spots” of interpersonal violence
            • Facilitate access to telehealth services with a Child Abuse Pediatrician 
            • Implement sustainability plan


            140 
            children were victims of an abuse 
             and neglect fatality/near-fatality

            80%
            of victims were ages 1–5 
            and 50% were <1

            64% 
            of perpetrators were biological
            parents acting together or alone

            63% 
            had prior 
            child welfare 
            involvement

            3 frameworks will be used in the development and implementation of the strategic plan: 21st Century Child Welfare System, Public Health Model, and Collective Impact.

            Community stakeholders will explore potential service gaps that may place children at risk for maltreatment including:

            Department of Child, Family and Adult Services

            • Public Health
            • Hospital Systems
            • Community-Based Service Programs and Organizers
            • District Attorney
            • Law Enforcement
            • Mental Health
            • School Systems

            Protocols will include the following:

            • Deploy communications strategy to engage community
            • Conduct ongoing evaluation and lessons learned from retrospective review
            • Develop tools and communicate findings to adjust strategies
            • Implement sustainability plan

            Hartford, Connecticut averaged
            17.6
            substantiated cases of child
            maltreatment per 1000 children

            That is nearly
            2x
            the state and national average
            during the same period

            Challenges in strategic coordination and disconnect between organizations will be remedied through a community-based, public health approach.

            A multidisciplinary team of stakeholders comprised of state agencies and community-based organizations to:

            • Share data
            • Coordinate services
            • Facilitate community participation 
            • Develop an implementation plan of best practices

            In addition to facilitating information findings, Saint Francis will:

            • Standardize and improve data collection
            • Increase community awareness and participation in reducing child fatalities
            • Identify and initiate best practices

            Michigan Department of Health and Human Services

            Employ a Collective Impact Approach

            Enhance Level of Services for At-Risk Families

            Improve Safety Planning Across Michigan’s Child Protection System

            With input from an advisory panel, they will employ a collective impact approach to enhance the level of services for families in need of support and improve safety planning across Michigan’s child protection system. To improve the level of services for families, they will examine outcomes of current policies and practices related to families with low or moderate risk for child maltreatment to identify change recommendations. They will also partner with statewide or regional outreach efforts that focus on protective factors and work to promote these services to families. Finally, they will review current safety planning practices, assess the perceived needs, barriers, and facilitators to safety planning among child protective services workers and other professionals, and assess the perceptions of safety plans among persons with lived experience. Collectively, this information will be used to identify areas for practice change and inform the development of educational resources and supports to reinforce safety plan best practices. 

            This product was supported by cooperative agreement number 2019-V3-GX-K005,
            The OVC FY 2019 Reducing Child Fatalities and Recurring Child Injuries Caused by Crime Victimization demonstration initiative.